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dissociative disorders
understanding
dissociative
disorders
Understanding dissociative disorders
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Contents
What is dissociation? 4
Useful contacts 25
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Understanding dissociative disorders
What is dissociation?
Dissociation is one way the mind copes with too much stress, such as
during a traumatic event. The word dissociation can be used in different
ways but it usually describes an experience where you feel disconnected
in some way from the world around you or from yourself.
If you dissociate for a long time, especially when you are young, you may
develop a dissociative disorder. Instead of dissociation being something
you experience for a short time it becomes a far more common experience
and often the main way you deal with stressful experiences.
Psychiatrists have tried to group these experiences and give them names.
This can help doctors make a diagnosis of a specific dissociative disorders.
But you can have any of these dissociative experiences even if you don’t
have a diagnosed dissociative disorder.
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What is dissociation?
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Understanding dissociative disorders
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What are dissociative disorders?
You might experience dissociation and find it difficult to cope with even if
you don’t have a dissociative disorder (for example it might be a symptom
of another mental health problem). You can still seek help for this.
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Understanding dissociative disorders
See PODS and First Person Plural for more information on DID.
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What are the causes?
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Understanding dissociative disorders
no longer traumatic but you still act as if it is. And if the dissociation you
needed to protect yourself means you haven’t been able to process past
traumatic experiences.
You may get so used to using dissociation as a coping strategy that you
do not develop other strategies and you start to use dissociation to deal
with any kind of stress.
You may have heard of fight or flight. They are instinctive ways that we
respond to threatening situations. But if you can’t do these things (for
example if you are very young) then you may respond by ‘freezing’ or
‘flopping’.
• The freeze response makes the body immobile and releases
chemicals which ‘numbs’ your body and mind. You might feel
paralysed or unable to move.
• The flop response is where lots of the thinking processes in the
brain are shut off. Your muscles become floppy and you act a bit like
a zombie – doing what you are told without protest.
One theory suggests that whenever we think there is a threat, our body
reduces blood flow to areas in the front of our brain (the thinking,
analytical, rational part) and ‘turns on’ areas in our back brain (the
automatic, instinctive part).
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What are the causes?
Using our back brain to freeze or flop helps protect us from trauma that
we can’t prevent or run away from. But reducing the blood flow to the
front brain can make it more difficult to process what happens and may
mean we experience dissociative symptoms.
For example, you might store an experience in a way you can’t access day
to day (this is usually called amnesia). Or you might remember what
happened but don’t feel the emotions or sensations that were part of it
(this is usually called derealisation).
This can help you cope if the things that happened would be too much for
you to deal with all together as a child – but may prevent you from
developing one clear identity as you grow up.
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Understanding dissociative disorders
You can read more about the causes of dissociative identity disorder on
the PODS website.
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How will I be diagnosed?
The person assessing you should have specialist training and a good
understanding of dissociative disorders. (PODS can put you in touch with
people who have this training).
Not everyone finds it helpful to get a diagnosis. Even if you don’t get a
specific diagnosis you can still seek help for your symptoms.
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Understanding dissociative disorders
It may help to ask your doctor to refer you to a mental health professional
who knows about dissociation for a full assessment. If you are not
satisfied with the assessment and support you have received from local
mental health services then The Clinic for Dissociative Studies may be able
to help.
Mind’s resource ‘Seeking help for a mental health problem’ has information
about how to make sure your voice is heard, and what you can do if
you’re not happy with your doctor.
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How can I help myself cope?
Keep a journal
Keeping a journal can help you understand and remember different parts
of your experience. It could:
• include writing and artwork you do at different times and, if you
have DID, in different identity states
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Understanding dissociative disorders
Try visualisation
Visualisation is a way of using your imagination to create internal scenes
and environments that help you stay safe and contain difficult feelings and
thoughts. For example:
• you might find that imagining you are wearing protective clothing
helps you feel more relaxed in stressful situations
• it might help to imagine a place that feels safe to you (and your
different identity states) – when you feel anxious or threatened, you
can imagine going to this place for peace and safety.
Focus on the sensations you are feeling right now. You might find it helpful
to keep a box of things with different textures and smells (for example
perfume, a blanket and some smooth stones) ready for when you need it.
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How can I help myself cope?
First Person Plural has more tips for grounding and dealing with flashbacks
on their website (see ‘Useful contacts’ on p.25).
PODS produces DID Emergency Information cards which you can order for
free from its website (pods-online.org.uk).
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Understanding dissociative disorders
It’s important to remember that you aren’t alone and you don’t have to
put up with people treating you badly. Here are some options for you to
think about:
• Show people this information to help them understand more about
dissociative disorders.
• Talk to other people who have dissociative disorders by going to a
support group – or setting one up for yourself.
• Share your experience with others. Mind publishes blogs and video
blogs (mental health selfies) on its website.
• Know your rights. Mind’s legal rights resources provide more
information.
• Take action with Mind. See our campaigning page for details of the
different ways you can get involved with helping us challenge stigma.
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What treatments can help?
Talking treatments
Talking treatments are the recommended treatment for dissociative
disorders. Counselling or psychotherapy will help you explore traumatic
events in your past, help you understand why you dissociate and develop
alternative coping mechanisms. It can also help you manage your
emotions and your relationships.
Accessing therapy
Most talking treatments for dissociative disorders take several years, but
unfortunately in most areas the NHS offers short or medium term therapy.
This isn’t usually effective in treating dissociative disorders.
You may need to be very persistent to get the right help from the NHS, or
consider alternative ways to access treatment. An advocate may be able
to help. See Mind’s online pages on ‘Advocacy’ for more information.
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Understanding dissociative disorders
Choosing a therapist
Not all therapists are familiar with dissociation or working with trauma. It
may take time to find a therapist that feels right for you.
It’s absolutely fine to meet with as many therapists as you need to find
the one you want to work with. The therapist you choose should be:
• accepting of your experience
• willing to work with or learn to work with dissociation and trauma
• be prepared to work with you long term
Medication
There are no drugs that are licensed to treat dissociation. Your doctor
might offer you psychiatric medication to treat other symptoms or
problems you might experience because of – or as well as – a dissociative
disorder, such as depression, anxiety and panic attacks, suicidal feelings,
hearing voices and OCD.
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What is non-epileptic attack disorder (NEAD)?
You will only be given medication for dissociative identity disorder (DID) if
most of the different parts of your identity (or at least the dominant one)
experience the problem you want to treat.
This helps make it less intense and prevents too many traumatic
memories appearing too quickly (flooding). It should only be used when
you are feeling reasonably stable and by professionals who are
knowledgeable about treating dissociative disorders.
Although they don’t have a physical cause this does not mean that they
are not real or that you are acting.
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Understanding dissociative disorders
It can be really hard to see someone you care about experiencing the
symptoms of a dissociative disorder. But family and friends can really help.
This page has some suggestions for ways you can support them while also
looking after your own wellbeing.
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What can friends or family do to help?
There may be times when you can’t offer them the support they need.
Think about who is the best person to contact at these times. Have a look
at our information on supporting someone to seek help.
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Useful contacts
Useful contacts
Clinic for Dissociative Studies The International Society for the
Web: clinicds.co.uk Study of Trauma and Dissociation
Accepts NHS referrals. Website has (ISSTD)
useful information about dissociative Web: isst-d.org
disorders. Academic society providing
information for professionals and
Childline the general public about trauma and
Tel: 0800 1111 dissociation research.
Web: childline.org.uk
Support for children who are National Association for People
worried or upset about anything – Abused in Childhood
including abuse. Tel: 0808 801 0331 (freephone from
landline and mobiles)
Epilepsy Action Web: napac.org.uk
Web: epilepsy.org.uk Provides a range of services which
Information about non epileptic offer direct support to survivors of
attack disorder (NEAD). abuse.
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Understanding dissociative disorders
Useful contacts
PODS (Positive Outcomes for
Dissociative Survivors)
Tel: 0800 181 4420
web: pods-online.org.uk
Information, support and crisis
cards for people with a dissociative
disorder.
Survivors UK
Web: survivorsuk.org
Support for men who have
experienced rape or sexual abuse.
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What can friends or family do to help?
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